Whakapapa and Immanence: Towards an Ethics of Care

In her 1990 Guest Editorial for JAN, Lynda Law Harrison raised the question: ‘Can an ethic of caring in nursing be maintained?’ This is a provocative question to ponder once again as we move into a new era which witnesses the unravelling of timeless ethics and values that guide and sustain nursing as a moral endeavour which assures its universal professional covenant with the public. The current socio-political, medical-economic polemics of health (read sickness) care are arguably turning nursing away from human caring and its bedrock ethic of caring. The demands of modern medicine have turned nursing more towards technical-industrial, quantitatively time-bound, product-line, institutional demands of the job. Such westernized clinical views of humanity and compassionate, ethical, human caring services, leave little room for nurses to attend to the work that they love. The work nurses love, that calls them into nursing in the first place, is often the caring–healing relationships, the values, and the sense of purpose and meaning attached to the human dimensions of nursing. This deeper humanitarian, caring science endeavour and the work of caring–healing relationships, is grounded in the timeless ethic and ethos that guides the personal and professional life of nursing. Yet, this is the very ethic which has been and continues to be eroded by the dominant technical, medicalized, clinicalized, professionalized view of humans and nurses themselves. Ironically however, just as we can currently identify the dissonance between the caring ethic of nursing and the focus of the dominant system, we witness collapse and chaos from within, nationally and internationally. Harrison's (1990) JAN Editorial invites a revisit as we enter a new era of conflict with respect to ethics and values, and what is truly important in sustaining hospitals as well as the humanity of practitioners and patients alike. The concluding challenge of that editorial, 15 years ago, was to acknowledge that: ‘Nurse practitioners, administrators, educators, researchers and theorists must continue to work together to ensure that the ethic of caring remains an essential unique focus of our profession’ (p. 126). I could not agree more with Harrison's conclusion, but with an updated view for this new century. Since that editorial was published, some disturbing, yet paradoxical, dynamics are increasingly evident in the world of hospital nursing: for example, the growing shortage of nurses, exceeding any past shortages in Western countries, including shortage of nursing faculty; the rising tension between corporate models vs. professional models of health services; the institutional-scientific management tactics, driven by costs and economic gains; the continuing widespread stories of dispirited nurses; the breakdown of professional institutional standards for maintaining healthy and viable nurse-working conditions; and, in some instances, last-resort approaches towards quotas and nurse–patient ratios have now been selectively legislated. These growing dynamics within and without the profession, guided largely by economic imperatives, have hardened and shortchanged the ethic of caring. Nurses and nursing are detoured from the human caring mission towards demands to do more and more, but with less and less time and appreciation. At a deeper level, we have to acknowledge the dissonance between the disciplinary-ethical-moral foundation of human caring as ontology, and epistemology, as well as a philosophy and model of science that guides informed caring practices. Parker (2004) does not hesitate to name this dissonance by reminding us that every epistemology becomes an ethic. Thus, if nursing does not maintain its caring ethic, it and we suffer harmful consequences, which as Palmer puts it, can result in ethical formation or ethical deformation (italics added). Thus, critical issues and consequences are evident if we do not and cannot maintain the caring ethic in nursing, and if we are to sustain humanity itself. But do not despair! In the midst of all the difficulties of this era, consistent with chaos and complexity theory, a new order and pattern of hope and change seems to be emerging underneath the chaos at the surface. Perhaps because of, or in spite of, the tense dynamics and value-conflicts and growing dissonance, there is evidence of an ethic of caring re-emerging; indeed, having to be emerge, if the profession of nursing and the systems that require nursing care are to survive. To put things in another perspective regarding the broader standing of nursing in the world, once again, in the 2005 Gallup poll in USA, the public placed the nursing profession on top, with respect to honesty and ethics, above other major professions (http://www.gallop.com). This acknowledgement is a reinforcement of the importance of sustaining the caring ethic if we are to maintain our covenant with the public. The tension in the dominant approaches to hospitals and medical treatment is in stark contrast to the public's accelerating interest, if not demand, for professional integrity, honesty and ethics, along with complementary-alternative medicine and an increasing awareness of the relationship between spirituality and health (Watson 2006). A new model of expectation is now emerging from the professions and the public alike, inviting a new order to emerge. What is bringing me hope, is that I am currently witnessing an increasing number of hospitals, nursing and hospital executives giving greater and greater attention, dignity, voice, recognition and action towards transforming nursing from inside out. These transformation efforts are resulting in nursing returning to its timeless ethic and practices of human caring, in that these ethical, theory-guided professional practice models seek to make explicit the caring relationships, the knowledge, values, philosophy, theory and therapeutics that guide advanced professional practice. These developments are transforming the practitioners as well as conventional systems (Watson 2006). For more information and selected examples of these progressive organizations and their caring-guided projects, visit the Watson website (http://www.uchsc.edu/nursing/caring). Thus, what is emerging under the chaos is an internal shift whereby individual nurses, nurse leaders and the profession of nursing are together bringing forth its timeless paradigm of caring as a hopeful ethic for this time of erosion and despair. There appears to be a momentum to develop theory-guided practice models in the midst of current hospital reorganizations. This turn is consistent with the widely-heralded American Nurses Credentialing Center Magnet Hospital initiative in USA, inviting hospitals and nursing administrators and leaders to achieve national Magnet recognition (http://ana.org/ancc/magnet/index.html). This development, if done with integrity and authenticity for deep change, is heartening. It gives nursing a professional pride and theoretical model to excel in its most cherished human caring practices, guided by an underlying caring ethic. It also promotes clinical research, and nurses as clinical scholars and knowledge workers, which the system requires for its ethic and integrity as well as its commitment and accountability to its public. The 1990 JAN editorial by Harrison identified steps that administrators in healthcare organizations can take to minimize institutional barriers to caring, by ‘implementing policies that reflect respect and care for nurses’ (p. 126). Further, these policies would involve nurses in decision-making so that they could determine how to implement caring; could establish programmes that facilitate nurses meeting their personal, as well as professional responsibilities. Administrators need to support education and therapeutic communication of caring which have ‘significant economic benefits for healthcare organizations’ (p. 126). It seems that with the current turn towards having to maintain the caring ethic in nursing, as well as new views from informed nurse administrators and leaders and visionaries, we see Harrison's challenges being met within a new context for change. In conclusion, the challenges of Harrison remain, but with the need for renewed attention and articulation. Some of the work by Nyberg (1998) a nurse administrator and leader of one of the original Magnet hospitals in the USA, provided an early voice for some responsibilities of the Nurse Administrator within a Caring Model which are congruent with Harrison. However, these responsibilities have expanded, and have increasing importance if nursing is to sustain its caring ethic. They include some of the following (Watson 2006, p. 54): Understanding and communicating caring as philosophy and ethic for organizational processes, structures and relationships; Developing skills of caring behaviours, caring presence in formal–informal relationships with individuals and groups; Being alert and responsive to situation for modelling, creating, and articulating theoretical–philosophical–ethics of caring with staff and colleagues; Providing leadership in implementing and evaluating experimental-demonstration models of caring–healing theory-guided practices; Promoting and supporting research on caring and healing/health outcomes; Exploring relationships between and among data which document connections between caring theory-guided practice models, nurse retention, patient–nurse satisfaction, healing outcomes and costs; Serving as stewards of caring-economics-costs, by incorporating caring as a valuable economic resource and caring as the foundational ethical variable in cost–benefit ratios. Finally, nursing and medical systems are in a new era of having to reconstruct new models that are based on hope and possibilities that transcend old paradigm thinking – thinking that is still lingering from an industrial-product-line mindset, silent with respect to the human spirit as the source for change. However, as nursing matures, and as it realigns its responsibilities and ethical caring covenant directly with the public, it stands as a beacon of light for a new ethic and ethos that transcends all that has come before and informs the healthcare system at large as well as society as a whole. So, in addressing the rhetorical question: ‘Can an ethic of caring be maintained?’, my response – knowing what we know now – is: ‘How can the discipline and profession of nursing, in good faith to itself and its public, bear to NOT maintain and act on an ethic of caring?’

The role of nuns in the Catholic church as carers and caregivers has been given scant attention. This paper narrates a historical contextualised tale of an ethic of care, caregiving and caring. Interview data were drawn from a qualitative study of four Catholic nuns. Interviews were informal and conversational, with participants asked to reflect on how belonging to a religious order shaped their lives. The data was analysed for patterns that made sense of the data in terms of an ethic of care. Reflexivity is used as a methodological tool in the interpretation of the data to confound the simplicity of the storytelling as the researcher positions herself in the study. The Catholic nuns interviewed show how an ethics of care, caring, and caregiving can be enacted from, at times, a nebulous position. The implication is that an ethic of care is an important aspect of a religious community life and perhaps more broadly religious education.

Recent discussions concerning the ethics of nursing care have gained added impetus from articulations of the so-called 'ethic of care' in moral philosophy. This paper addresses the question of recognizing and elaborating the ethics of nursing care by exploring the problems and the possibilities of these intersecting discourses. In the first part of the paper it is argued that appropriation of 'the ethic of care' by nursing theorists as the central value of nursing, in contradistinction to other moral values such as beneficence or justice, runs the risk of reinforcing the conventional approaches to ethics that 'the ethic of care' seeks to overturn. Central to 'the ethic of care' is the recognition that caring entails a focus on the particularities and context of the relationships in which it is expressed. Accordingly the application of a unitary concept of care to the context of nursing relations may seriously distort their diverse and complex-specific ethical possibilities. The dynamic complexity of nursing ethics may be more adequately understood by working through an array of specific examples of nursing practice highlighting the differences and similarities between them and other ethical practices of care. Experience of a set of examples in this way will draw attention to the multiplicity, ambiguity, and particularity of the ethics of nursing care. In the second part of the paper a beginning is made on this project by addressing the work of several different theorists of care who have examined different practices of nursing from the overlapping perspectives of nurses, patients and the socio-historical construction of their relationships.

Ethical care involves respecting human values, professional conscience, cultural and religious beliefs, personal appearance, confidentiality, and providing high-quality nursing services. In pediatric wards, ethical challenges are often more intense and complex than in adult care, which can increase the risk of neglecting the rights of children and their families. To address this, healthcare centers employ various methods to enhance ethical care. Since there is little research on ethical pediatric care in Gorgan, northern Iran, this study aims to evaluate Ethical Pediatric Nursing Care and Associated Factors among Nurses in Pediatric. This cross-sectional study was conducted in 2024 among 133 nurses working in pediatric and neonatal departments in Specialized Children’s Educational and Therapeutic Center in Gorgan. According to the sampling framework and the estimated number of participants from each section, participants were selected through simple random sampling. Data were collected using a demographic-professional characteristics questionnaire and the Children’s dimensions Ethical Care Questionnaire developed by Khalili et al. (2023). Data analysis was performed using SPSS version 26 with Mann–Whitney U and Spearman correlation coefficient tests. A p-value of < 0.05 was considered statistically significant. The mean age of the participants was 35.30 ± 8.73 years. The mean total score of pediatric ethical care was 162.19 ± 14.39, which indicates a desirable level. Among the dimensions, the lowest and highest mean scores were observed in welfare needs (3.97 ± 0.86) and medical needs (4.53 ± 0.42), respectively. Pediatric ethical care was significantly associated with several personal and professional characteristics of nurses, including gender (p = 0.001), work shift (p = 0.042), job title (p = 0.025), employment type (p = 0.007), age (p = 0.001), and work experience (p = 0.001). Although pediatric nurses generally provided good ethical care, more attention is needed to address children’s welfare needs. Nurses should focus more on supporting the welfare of hospitalized children and infants, respecting their rights. Training programs targeting these areas are recommended to improve nurses’ performance.

Back to table of contents Next article Taking IssueFull AccessManaged Care or Ethical Care: What's in a Name?H. Steven Moffic, M.D., H. Steven MofficSearch for more papers by this author, M.D., Psychiatry and Behavioral Medicine Department, Medical College of Wisconsin, MilwaukeePublished Online:1 Aug 2003https://doi.org/10.1176/appi.ps.54.8.1063AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Just hearing the term "managed care" is often enough to raise the hairs and pulses of most clinicians. At the 2002 "Behavioral Healthcare & Informatics Tomorrow" conference, Charles G. Ray, M.Ed., who is president and chief executive officer of the National Council for Community Behavioral Health, said that he no longer uses the term. To Mr. Ray and others, the term "managed care" just has too many negative associations with questionable management practices.What should replace the term? It seems that we need a term that does not ignore the problems managed care was supposed to address and one that will be widely accepted among payers, clinicians, the public, and even politicians.In the past, James Sabin, M.D., who is editor of the Managed Care column in Psychiatric Services, has advocated for the term "ethical managed care" as an alternative. However, that has not caught on, possibly because it includes the term "managed care" or because it is too long.Why not drop the word "managed" from Dr. Sabin's recommendation and use "ethical care"? Presumably no one would be offended by this term, and it would not ignore the cost issues influencing managed care. The preamble to the American Psychiatric Association's Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry states, "a physician must recognize responsibility not only to patients, but also to society."This principle acknowledges the importance of costs but keeps the patient primary. When we use the word "ethical," we recognize the fact that as professionals we have widely accepted principles that can be referred to and used as national standards.If we can replace the term "managed care," then maybe we can also replace its derivative, "behavioral" health care. Behavioral generally refers only to observable, and possibly measurable, characteristics of a patient. This term seems to fit the focus of managed care—that functioning, not internal suffering, is the most important issue for insurance coverage. Our ethics as health care professionals require us to attempt to alleviate psychological suffering whenever possible. Therefore, when we need to refer to our own specialty, "ethical psychiatric care," or more broadly, "ethical mental health care," would be preferable to "behavioral health care." After all, isn't it our minds that really make us human? FiguresReferencesCited byDetailsCited byNone Volume 54Issue 8 August 2003Pages 1063-1063 Metrics PDF download History Published online 1 August 2003 Published in print 1 August 2003

Background: Ethical care is concerned with aspects of work that may influence nurses’ ethical behavior. Intensive care units might expose nurses to moral judgment while caring. This qualitative study aimed to explain the nurses’ experience of moral judgment in intensive care units. Methods: The present qualitative study was conducted using the conventional content analysis method. The participants of the study included 23 nurses working in the intensive care units (ICU, CCU, NICU) of four hospitals affiliated with Sabzevar University of Medical Sciences who were selected using purposive sampling. The data were collected through semi-structured interviews. The questions asked in the interviews included, "Would you please describe one working day of yours caring in the intensive care units?" and "While caring, did you have to hesitate to make a decision ethically? If yes, would you describe that situation?" The Data were analyzed using the qualitative content analysis method proposed by Graneheim and Lundman. Results: Data collection and analysis led to the identification of 1 theme, 6 categories, and 23 subcategories. The identified theme was "intensified tension and conflict following ethical patient care in the intensive care units" and the categories were "repeated exposure to stress in ethical patient care in the intensive care units", "ethical care originated from the nurses’ beliefs", "moral judgment in care affected by the patient’s clinical condition", "moral judgment as a consequence of clinical judgment", "ethical care based on organizational and legal conditions in the moral environment", and "requirements of ethical care". Conclusion: The nurses in the intensive care units deal with ethical issues and are under a lot of stress. The results of this study can help nursing authorities pay more attention to developing ethical knowledge and ethical considerations in hospitals and provide organizational support to identify the moral tensions of nurses in intensive care units.

Reply by Carol Gilligan

Introducing new technologies into healthcare practices may challenge professionals' traditional care cultures. The aim of this review was to map how the 'ethics of care' theoretical framework informs empirical studies of technology-mediated healthcare. A scoping review was performed using eight electronic databases: CINAHL with full text, Academic Search Premier, MEDLINE, the Philosopher's Index, SocINDEX with Full Text, SCOPUS, APA PsycInfo and Web of Science. This was followed by citation tracking, and articles were assessed against the inclusion criteria. Of the 443 initial articles, 18 met the criteria and were included. We found that nine of the articles used the concept of 'ethics of care' (herein used interchangeably with the terms 'feminist ethics' or 'relational ethics') insubstantially. The remaining nine articles deployed care ethics (or its equivalent) substantially as an integrated theoretical framework and analytical tool. We found that several articles suggested an expansion of ethics of care to encompass technologies as part of contemporary care. Furthermore, ethics of care contributed to the empirical research by recognising both new relationships between patients and healthcare professionals as well as new ethical challenges. Ethics of care is sparsely used as a theoretical framework in empirical studies of technology-mediated healthcare practices. The use of ethics of care in technology-mediated care brings new dilemmas, relational tensions and vulnerabilities to the foreground. For ethics of care to be used more explicit in empirical studies, it is important that it is recognised by research community as an adequate, universal ethical theory.

BackgroundMoral sensitivity refers to the interpretive awareness of moral conflict and can be justice or care oriented. Justice ethics is associated primarily with human rights and the application of moral rules, whereas care ethics is related to human needs and a situational approach involving social emotions. Among the core brain regions involved in moral issue processing are: medial prefrontal cortex, anterior (ACC) and posterior (PCC) cingulate cortex, posterior superior temporal sulcus (pSTS), insula and amygdala. This study sought to inform the long standing debate of whether care and justice moral ethics represent one or two different forms of cognition.Methodology/Principal FindingsModel-free and model-based connectivity analysis were used to identify functional neural networks underlying care and justice ethics for a moral sensitivity task. In addition to modest differences in patterns of associated neural activity, distinct modes of functional and effective connectivity were observed for moral sensitivity for care and justice issues that were modulated by individual variation in moral ability.Conclusions/SignificanceThese results support a neurobiological differentiation between care and justice ethics and suggest that human moral behavior reflects the outcome of integrating opposing rule-based, self-other perspectives, and emotional responses.

Since the publication of Carol Gilligan's In a different voice in 1982, there has been much discussion about masculine and feminine approaches to ethics. It has been suggested that an ethics of care, or a feminine ethics, is more appropriate for nursing practice, which contrasts with the 'traditional, masculine' ethics of medicine. It has been suggested that Nel Noddings' version of an 'ethics of care' (or feminine ethics) is an appropriate model for nursing ethics. The 'four principles' approach has become a popular model for medical or health care ethics. It will be suggested in this article that, whilst Noddings presents an interesting analysis of caring and the caring relationship, this has limitations. Rather than acting as an alternative to the 'four principles' approach, the latter is necessary to provide a framework to structure thinking and decision-making in health care. Further, it will be suggested that ethical separatism (that is, one ethics for nurses and one for doctors) in health care is not a progressive step for nurses or doctors. Three recommendations are made: that we promote a health care ethics that incorporates what is valuable in a 'traditional, masculine ethics', the why (four principles approach) and an 'ethics of care', the 'how' (aspects of Noddings' work and that of Urban Walker); that we encourage nurses and doctors to participate in the 'shared learning' and discussion of ethics; and that our ethical language and concerns are common to all, not split into unhelpful dichotomies.

LANGUAGE NOTE | Document text in Chinese; abstract also in English.墮胎是當代最具爭議性的道德問題之一。但問題的焦點是否是婦女選擇墮胎的權利與胎兒生存權利的取捨？究竟以權利立論為婦女爭取墮胎的自由是否適切？以權利立論是否沒有限制？婦女在考慮墮胎時，是否以從權利的角度出發作決定呢？如果婦女考慮墮胎時，是從關懷的角度出發作決定，則此進路由是否沒有問題呢？當然，如果論辨的雙方能夠彼此了解及對話，能否為解決此爭拗帶來甚幫助呢？本文將會介紹湯森（Judith Jarvis Thomson）及沃倫（Mary Anne Warren）以權利立論為婦女爭取墮胎權的立場，趙凌姬（Carol Gilligan）關懷倫理及徐姿（Laurie Shrage）詮釋及多元的道德進路，並嘗試了解不同進路的限制，目的並不是要解決道德問題，卻是要深化我們對這問題的複雜性的體認。Abortion is one of the most controversial moral problems in contemporary world. People believe that the heart of the problem is the conflict between the fetuses' right to life and the women's rights to abortion. However, do women take their rights seriously when they decided to go for an abortion? Or one should look at the issue from the interpretive and pluralist approach? This essay is an attempt to introduce our readers to the problem by looking at three feminist approaches.Judith Jarvis Thomson and May Anne Warren represent those feminists defending the rights of women to choose abortion. Thomson argues that abortion is justified, even if the fetus has a right to life. For a woman should have the right to refuse the use of her body to a dependent fetus. It is not the obligation of the woman to afford the fetus that use. However, is it morally justifiable for a woman, who willingly accepted the pregnancy, yet suddenly use her right to abortion after hosting the fetus for several months?What Warren argues is that a fetus does not have those traits characterize "personhood". Since the fetus is not a person, its right to life should not override the right of a woman to choose abortion. However, it is dangerous to use the concept of personhood as a criterion of exclusion. To question someone's personhood is the first step to mistreatment and killing.While feminists are trying to defend their right to abortion, there are some women abusing their rights. There are women who choose to abort for what they carry are female fetuses. There are also some risked abortions for they do not want to postpone or diminish their partners' sexual pleasure. Moreover, while feminists are defending their rights, are they at the same time oppressing the vulnerable fetuses? Therefore, recently, more and more theorists dissatisfied with rights-based approaches to abortion.Moreover, according to Carol Gilligan, when women consider for abortion, they do not take the male ethics of duty or obligation. That means they do not approach the decision by rights-based arguments. Usually what women take is an ethics of responsibility or care. Women are more inclined to reflect on how their decisions on abortion might affect the quality of their relationships. Women are making moral decisions in terms of their understanding of the relative importance of their interests versus the interests of others close to them. Although women forgo the right-based approach, the ethics of care is not without its problem. For when similar responsibilities are in conflict, the ethics of care could not provide any means to give a resolution.What Laurie Shrage advocates is an interpretive, pluralist approach to abortion. She sees the struggle over the women right to abortion as an indicative of deep cultural conflicts over a range of issue including not only the personhood of fetus, but also the meaning of life itself and how it should be lived by women and others. People involved in the debate have different cultural understandings of person hood as well as motherhood. What they need to do is to understand one another and dialogue with a view lo reaching a compromise. Although what Shrage proposed is promising, however, abortion is a life and death issue fueled with emotion. Even the two sides could try to grasp an in-depth understand the other's position, they might not be able to reach an agreement. The abortion issue is not a problem easy to reach a resolution.DOWNLOAD HISTORY | This article has been downloaded 214 times in Digital Commons before migrating into this platform.

This paper reviews briefly the main approaches in the literature on ethics of war and suggests the need to move beyond an ethic of justice towards an ethic of care. The analysis problematizes dominant understandings of "just war" and "just peace" in the literature and highlights that incorporating elements of an ethic of care, our understanding of ethics of war and peace can be redefined, sharpened, and redeployed through an enlarged ethical lens. The author suggests that scholars and practitioners in different fields of study and domains of social and political life can make important contributions by defining, elucidating, and advocating why both perspectives, those of ethic of justice and care, together allow us to capture the prospects of a broader understanding and the practice of peace.

PurposeThis study aims to think critically about collaborative working through the practical application of an ethics of care approach. The authors address the following research questions: How can the authors embed an ethics of care into academic collaboration? What are the benefits and challenges of this kind of collaborative approach? The contextual focus also incorporates a collective sense making of academic identities over the course of the COVID-19 pandemic.Design/methodology/approachThe authors focus on the activities of the “Consumer Research with Impact for Society” collective at and around the 2021 Academy of Marketing conference. The authors draw on the insights and labour of the group in terms of individual and collaborative reflexivity, workshops and the development of a collaborative poem.FindingsFirst, the authors present the “web of words” as the adopted approach to collaborative writing. Second, the authors consider the broader takeaways that have emerged from the collaboration in relation to blurring of boundaries, care in collaboration and transformations.Originality/valueThe overarching contribution of the paper is to introduce an Ethics of Collective Academic Care. The authors discuss three further contributions that emerged as central in its operationalisation: arts-based research, tensions and conflicts and structural issues. The application of the “web of words” approach also offers a template for an alternative means of engaging with, and representing, those involved in the research.

ABSTRACTThis article addresses care as a socially, culturally, historically, and politically constituted ‘process’ and relates to ethnographic data gained during long-term anthropological fieldwork in Daiden, a place in the Lower Ramu River area of Papua New Guinea. It focuses in particular on the situation of elderly people as well as on intergenerational shifts. Analytically, the four dimensions of care (caring about, taking care of, care-giving, care-receiving) and their related values (attentiveness, responsibility, competence, responsiveness), as developed within the ‘ethics of care’ framework by feminist scholars are applied in order to delineate the remaking of local ethics of care in the face of wider contemporary societal transformations. By means of a ‘life-course perspective’ the article aims to shed light on the ways in which such a remaking has been perceived and evaluated in Daiden, thus augmenting the idea of care as a process rather than as a natural and/or atemporal disposition. The article also tackles pressing social welfare issues in contemporary Papua New Guinea in a more general way.

The doctor-patient relationship is an essential determinant of quality of healthcare, especially in elderly care as the older adults are more vulnerable in comparison to other age groups. Patients and doctors engage in a consensual relationship in which the patient seeks health-related assistance, and the service provider agrees to provide the highest standard of care, treatment options and to maintain confidentiality. Sometimes information only known by doctors and not disclosed to family members or relatives illustrates the immense trust placed by patients on doctors. This type of care involves four key elements—mutual knowledge, trust, loyalty and regard which will be discussed using the three basic models of the doctor-relationship including Active–Passive Model, Guidance-Cooperation Model and Mutual Participation Model. The American Nurses Association adopts The Code of Ethics to guide professionals towards treatment of their patients to ensure professional ethics in care and to address ethical issues that are likely to arise involving the elderly. Some of the vulnerabilities found in professional ethics in elderly care are incidences of error, neglect and abuse. The aim of this chapter is to discuss doctor-patient relationship and professional ethics in elderly care, and explore what can be done to achieve the highest level of care.KeywordsDoctor-patient relationshipQuality of careElderly careProfessional ethics